Analyzing Healthcare

Host Roy Bejarano sits down with Mark Jamilkowski, a seasoned actuary and healthcare executive, to explore the dynamics of the healthcare payer industry, the challenges facing self-insured employers, and barriers to entry for new insurance providers.In this episode, Mark shares insights into how government regulations, Medicare Advantage, and payer-provider relationships shape the industry. He also discusses his experience launching Every Health, a new insurance model focused on digital health integration and care coordination. This conversation is a must-listen for healthcare leaders, investors, and innovators navigating the ever-evolving payer landscape.Timestamps:[00:01] Introduction to Mark Jamilkowski and his 30-year career in the healthcare industry[02:09] Understanding the payer landscape: Medicare, Medicaid, and employer-based insurance[05:55] The economics of Medicare Advantage and why insurers focus on this market[12:28] Myths vs. realities of the self-insured employer market[22:33] –you Launching Every Health: How to break into the insurance industry[40:47] The role of digital health, value-based care, and provider partnerships in the future of healthcareKey Takeaways:Market Segmentation Defines Success – Large payers like UnitedHealth, Humana, and Centene approach different market segments strategically, favoring high-margin Medicare Advantage plans.Government Influence is Unavoidable – Over 65% of U.S. healthcare spending is government-funded, shaping the priorities and strategies of insurers.Self-Insured Employers Are Not Taking Over – Contrary to industry narratives, the percentage of self-insured employers has remained stable for decades, despite broker-driven hype.Technology & Value-Based Care Will Drive the Future – Innovations in digital health, data analytics, and care coordination are reshaping how payers and providers interact, with companies like Every Health leading the charge.Connect with the Guest: Website: Evry Health LinkedIn: Mark JamilkowskiAbout Mark Jamilkowski:Mark Jamilkowski is a healthcare industry veteran with over 30 years of experience as an actuary, investment banker, and entrepreneur. He has held leadership positions at Aetna, Big Four consulting firms, and venture-backed insurance startups. As co-founder of Every Health, he is pioneering digital-first insurance solutions that integrate value-based care and provider partnerships to enhance patient outcomes. Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Health Insurance Market, Medicare Advantage, Self-Insured Employers, Digital Health Solutions, Value-Based Care, Payer Market Strategy, Healthcare Consolidation, Insurance Industry Disruption, Mark Jamilkowski,

Roy Bejarano sits down with Lancer Seaman, an expert in healthcare IT and business intelligence, to discuss the transformative role of data analytics in healthcare leadership. The conversation explores healthcare trends, healthcare innovations, and the importance of business intelligence in medical service organizations (MSOs) and physician management services.Lancer shares his experience in optimizing healthcare IT systems, addressing physician burnout, and how healthcare industry insights can drive patient care improvements. This discussion is essential for healthcare executives, IT professionals, and medical providers looking to harness business intelligence in healthcare for operational success and strategic growth.Timestamps:[00:00] Introduction to Roy Bejarano & Lancer Seaman – The Role of Healthcare IT & Business Intelligence[05:02] Physician Burnout & Technology – How Healthcare Innovations Improve Physician Efficiency[10:51] Due Diligence in Healthcare Mergers & Acquisitions – Key IT Risk Assessments in MSOs[19:47] The Impact of Data Analytics on Patient Outcomes – Improving Clinical & Surgical Efficiencies[27:46] Standardizing Healthcare IT Systems for Scalability & Cost Savings[50:54] Proof of Concept in Healthcare IT Investments – Reducing Risk & Cost of ImplementationKey Takeaways:Data Analytics is Reshaping Healthcare Leadership: Healthcare trends are shifting towards business intelligence, driving operational efficiency and patient outcomes.Physician-Centric IT Systems Reduce Burnout: Healthcare innovations in AI, automation, and data standardization help reduce administrative burden and optimize physician workflows.Standardization is Key to Scaling Healthcare Organizations: Effective healthcare IT integration ensures seamless data sharing, compliance, and organizational efficiency.Business Intelligence in Healthcare is a Profit Driver: Healthcare industry insights reveal that data analytics can lead to cost savings, optimized patient care, and new revenue opportunities.Connect with the Guest:Website: Scale HealthcareLinkedIn: Lancer Seaman About Lancer Seaman:Lancer Seaman is a healthcare IT & business intelligence expert with over 30 years of experience in healthcare leadership, data analytics, and operational optimization. Having served as CIO for multiple MSOs and healthcare organizations, he has helped healthcare leaders leverage data-driven strategies to improve efficiency, patient outcomes, and cost reduction.Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Business Intelligence in Healthcare, Data Analytics in Healthcare, Healthcare IT Strategy, Medical Service Organizations (MSOs), Physician Burnout, Patient Outcomes, Healthcare Mergers & Acquisitions, Value-Based Care,

Roy Bejarano sits down with Jonathan Kron, a healthcare IT and business intelligence expert, to explore the differences between the US and UK/European healthcare markets. This discussion delves into healthcare industry insights, the role of healthcare IT strategy, and the challenges faced by medical service organizations (MSOs) when expanding into international markets.Jonathan shares his experience in healthcare leadership, highlighting the opportunities and risks associated with global healthcare trends, market expansion, and healthcare innovations that drive strategic decision-making. The conversation is crucial for healthcare executives, investors, and policy-makers looking to navigate the complexities of cross-border healthcare operations.Timestamps:[00:00] Introduction to Roy Bejarano & Jonathan Kron – Understanding Healthcare Market Differences[05:30] US vs. UK/European Healthcare Models – Key Structural and Financial Differences[11:45] Market Opportunities & Challenges – Expanding Healthcare Businesses Internationally[18:20] Role of Healthcare IT Strategy – Leveraging Data Analytics for Market Expansion[26:50] Physician Engagement & Operational Efficiency – Lessons from Different Healthcare Systems[39:15] Healthcare Mergers & Acquisitions – Best Practices for Cross-Border IntegrationsKey Takeaways:Healthcare markets vary significantly between the US and UK/Europe. Understanding financial models, government involvement, and patient expectations is crucial for successful expansion.Healthcare IT strategy is key to market entry. Leveraging data analytics and business intelligence helps organizations optimize operations across global healthcare markets.Physician engagement is critical in different regulatory environments. Organizations must align compensation structures, performance metrics, and workflow efficiencies to fit local standards.Healthcare mergers & acquisitions require strategic alignment. Successful cross-border deals depend on operational integration, cultural adaptation, and compliance with local regulations.About Jonathan Kron:Jonathan Kron is a healthcare IT & business intelligence expert with over 30 years of experience in healthcare leadership, IT strategy, and operational optimization. Having worked with global healthcare markets, he specializes in data-driven decision-making, cross-border healthcare expansion, and market entry strategies for medical organizations looking to scale internationally.Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Global Healthcare Markets, UK Healthcare System, European Healthcare Trends, Healthcare IT Strategy, Market Expansion, Physician Engagement, Medical Service Organizations (MSOs), Healthcare Mergers & Acquisitions, Jonathan Kron,

Roy Bejarano sits down with David Drzewiecki, CEO of Absolute Dental, to explore the growth, challenges, and innovations shaping the dental service industry (DSOs). The discussion covers healthcare trends, technology advancements in dentistry, the expansion of value-based care, and how Medicaid dental programs are evolving.David shares insights on healthcare leadership, the future of patient experience, and how Absolute Dental has built a successful all-in-one model for specialty and general dentistry. The conversation is essential for healthcare executives, investors, and dental professionals looking to understand the next phase of dental care consolidation and innovation.Timestamps:[00:00] Introduction to Roy Bejarano & David Drzewiecki – The Evolution of Absolute Dental[03:00] Growth of DSOs Over the Last 10 Years – Market Consolidation & Industry Shifts[07:15] The Role of Medicaid & Medicare in Dental Care – Expanding Access & Reimbursement Challenges[12:30] Technology’s Impact on Patient Experience – AI, Teledentistry & Standardization[18:00] Value-Based Care in Dentistry – The Path to Greater Payor Engagement[24:45] Strategic Partnerships & Growth Opportunities – ACOs, Medicare Advantage & Direct Contracting[30:30] Specialty Dental Services – The Role of Oral Surgery, Orthodontics & Pediatric Dentistry[38:15] The Future of Dentistry – Innovation, Expansion & Workforce ChallengesKey Takeaways:DSOs continue to grow, but misconceptions persist. Many believe the market is already consolidated, yet dental care still has significant room for expansion.Technology is transforming patient experience. Innovations like AI-driven x-ray analysis, teledentistry, and automated scheduling are improving patient access and clinical outcomes.Value-based care in dentistry is still developing. As Medicaid and Medicare Advantage expand, DSOs must engage with payers to drive cost-effective, outcomes-focused care.All-in-one dental care models enhance patient retention. Offering general, specialty, and surgical dental services in one location prevents patient leakage and improves continuity of care.About David Drzewiecki:David Drzewiecki is the CEO of Absolute Dental, Nevada’s largest Medicaid dental provider with nearly 40 practices. With a background in healthcare IT, revenue cycle management, and dental practice operations, he has led Absolute Dental through expansion, innovation, and strategic payer engagement. His expertise offers valuable insights for DSO leaders, healthcare investors, and technology innovators in the dental industry. Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Dental Service Organizations (DSOs), Medicaid Dental Care, Patient Experience in Dentistry, Value-Based Care, Specialty Dental Services, Oral Surgery, Teledentistry, Dental Technology,

Host Roy Bejarano sits down with Amir Dan Rubin, an industry veteran and former CEO of One Medical, Stanford Health, UCLA Medical, and United Healthcare’s Optum. Now leading Healthier Capital, a venture fund dedicated to AI-driven healthcare innovations, Amir shares a holistic perspective on the intersection of technology, business strategy, and healthcare transformation.This conversation explores how AI, value-based care, payer models, and care coordination must work together to drive sustainable innovation. Amir explains how AI can improve patient engagement and operational efficiency, but only when aligned with existing healthcare systems and incentives. He also delves into the challenges of scaling risk-based care models, the evolving role of health systems, and why execution is just as critical as strategy.Timestamps:[00:00] Introduction to the podcast and guest, Amir Dan Rubin[02:00] Managing for-profit vs. non-profit healthcare: How leadership, funding, and decision-making differ[06:30] The impact of private equity and venture capital on healthcare leadership[12:00] The One Medical playbook: How strategic primary care innovation led to its acquisition by Amazon[18:00] AI in healthcare: The biggest opportunities and risks for AI-driven healthcare innovations[24:30] A holistic approach to healthcare transformation—aligning AI, patient engagement, and care coordination[30:00] The challenge of coordinating care across specialties and health systems[40:00] Value-based care: Is it working? Lessons from Medicare Advantage and risk-based models[50:00] AI in action: How Healthier Capital is funding the next wave of AI healthcare startups[1:00:00] What’s next: Amir’s vision for AI, digital health, and healthcare transformationKey Takeaways:For-profit and non-profit healthcare models each have strengths—but focus and execution matter most. Nonprofits benefit from tax advantages and academic affiliations, while for-profits have greater agility in decision-making and innovation.One Medical’s success stemmed from a hybrid model that improved access and efficiency. By offering tech-enabled primary care with a membership model and employer partnerships, One Medical bridged gaps in value-based care and traditional fee-for-service models.AI is a game-changer for patient care and operational efficiency. AI-driven tools can automate administrative tasks, enhance clinical decision-making, and improve patient engagement, but they must be secure, compliant, and seamlessly integrated into existing workflows.Value-based care is complex, but risk is risky. Many healthcare groups struggle with financial sustainability in global capitation models, but data-driven care coordination and AI-driven risk stratification can help reduce costs while improving patient outcomes.Health systems will increasingly partner with AI startups to modernize care delivery. Large tech firms like Amazon, Google, and Optum are investing in AI healthcare solutions, but the most impactful innovations often come from specialized startups solving specific industry challenges.Resources:Healthier Capital WebsiteLinkedInAmir Dan Rubinis a distinguished healthcare executive renowned for his transformative leadership in innovative healthcare delivery. As the former CEO of One Medical, a membership-based primary care practice, Rubin spearheaded its national expansion, increased its membership base, and successfully led the company to a public offering in January 2020.Rubin’s impressive career includes pivotal roles in leading healthcare organizations. He served as President and COO of UnitedHealth Group’s Optum and as CEO of Stanford Health Care, where he championed the integration of advanced technology and patient-centered care. His expertise lies in healthcare transformation, innovation, and leveraging digital tools to enhance patient experiences.Rubin holds an MBA from Stanford University, an MHA from the University of Michigan, and a Bachelor’s degree in Economics from the University of California, Berkeley. His contributions have significantly impacted how healthcare organizations utilize technology to provide more accessible and patient-focused care.Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, AI in Healthcare, Value-Based Care, Digital Health, Venture Capital in Healthcare, Health System Strategy, Amir Dan Rubin, One Medical, Stanford Health, UCLA Medical, United Healthcare’s Optum, Holistic Healthcare,

Host Roy Bejarano sits down with Jeff Staser, CFO of Straine Dental, to explore the evolving DSO market, the impact of private equity in healthcare, and the future of dental investments. As a dental industry veteran with decades of experience in scaling DSOs, optimizing financial models, and practice management, Jeff shares key insights on what makes Straine Dental’s ownership model unique, how hygiene departments drive revenue, and why data-driven decision-making is crucial for DSOs.This episode covers the differences between Straine Dental and traditional DSOs, common mistakes dental practices make, and how AI in healthcare and DSOs will shape the future of the industry.Timestamps:[00:00] Introduction to the podcast and guest, Jeff Staser, CFO of Straine Dental[02:00] Jeff’s background: From Heartland Dental to Straine Dental’s growth strategy[06:30] The origin of Straine Dental and its unique ownership structure[10:00] Why hygiene departments are a key driver of revenue for DSOs[14:30] How most independent dental practices fail to optimize operational efficiency[18:00] The role of private equity in shaping the future of DSOs[22:30] The importance of KPIs and analytics in DSO success[26:00] How AI and technology are changing the DSO landscape[30:30] The biggest challenges and resistance dentists face when scaling their practices[35:00] Jeff’s predictions for the future of DSOs and dental consolidation trends[40:00] Final thoughts and closing remarksKey Takeaways:Straine Dental prioritizes dentist ownership in its DSO model. Unlike traditional private equity-backed DSOs, Straine ensures that clinicians maintain majority ownership, aligning incentives for long-term practice growth.Hygiene departments are a hidden driver of DSO success. Many dental practices underinvest in hygiene, missing out on significant revenue opportunities that could improve patient care and practice performance.Private equity in healthcare is accelerating DSO consolidation. Large DSOs are focusing on de novo growth instead of acquisitions, leading to fewer opportunities for individual dentists to sell their practices in the future.The future of the DSO market will resemble healthcare systems. Larger dental groups will increasingly adopt medical-like structures, integrating technology, data-driven management, and operational efficiencies.Resources:Website- https://dykemadso.com/LinkedIn- https://www.linkedin.com/in/jeff-staser-0530a71a/About Jeff Staser:Jeff Staser is a dental industry expert with extensive experience in DSO financial strategy, private equity investment, and dental practice management. As the CFO of Straine Dental, he has played a pivotal role in scaling DSOs, optimizing financial models, and ensuring long-term growth for dentist-owned organizations. Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Private Equity in Healthcare, Dental Support Organizations (DSOs), Dental Investments, AI in Healthcare, Jeff Staser, Straine Dental,

Host Roy Bejarano sits down with Scott Herman, CEO of New Day Healthcare, to discuss how home healthcare is evolving, the challenges of scaling a home care platform, and how AI is transforming care delivery. New Day Healthcare, founded in 2020, has rapidly grown to 120,000 patients, 7,000 team members, and 29 locations across five states, making it one of the fastest-growing home health providers in the industry.In this episode, Scott shares insights into the importance of technology-driven home care models, how New Day differentiates itself from traditional home care providers, and why AI-driven analytics are crucial for improving patient outcomes. He also explains how Medicare Advantage is reshaping home care, why avoiding the acquisition "value trap" is essential, and how his company is pioneering a virtual-first home healthcare model.Timestamps:[00:00] Introduction to the podcast and guest, Scott Herman, CEO of New Day Healthcare[02:00] Scott’s background: From paramedic and nurse to leading major home health platforms[06:00] How New Day Healthcare differs from traditional home care providers[10:00] Why a virtual-first corporate model reduces overhead and improves patient care[14:30] How New Day avoids the acquisition "value trap" when scaling[18:00] The role of AI in healthcare: How New Day uses predictive analytics to manage patient care[22:00] Why Medicare Advantage is driving major change in home healthcare[26:30] The challenges of integrating different EMRs and billing systems[30:00] How AI-driven automation is streamlining patient referrals and intake[35:00] The future of home healthcare: AI, predictive analytics, and strategic partnerships[40:00] Final thoughts and Scott’s predictions for the future of the home care industryKey Takeaways:New Day Healthcare is revolutionizing home care with a virtual-first model. By eliminating corporate overhead and using AI-powered automation, New Day is able to deliver more resources to bedside care.AI in healthcare is transforming home health operations. Predictive analytics, AI-driven patient tracking, and automated referral processing are helping New Day reduce hospitalizations and improve patient engagement.Avoiding the "value trap" in acquisitions is key to sustainable growth. Unlike other home care providers, New Day focuses on middle-tier acquisitions and leverages AI to optimize operations instead of overpaying for premium assets.Medicare Advantage is forcing home health providers to rethink their business models. With 53% of Medicare patients now enrolled in MA plans, New Day is adapting to lower-margin, high-volume care models.Strategic partnerships must be carefully structured. Scott explains why many home care providers fall into inefficient strategic alliances and how New Day selectively engages in payer and provider partnerships.Resources:New Day Healthcare Website https://www.newdayhealthcare.com/LinkedIn: Scott Herman https://www.linkedin.com/in/g-scott-herman-10a9a1178/About Scott Herman:Scott Herman is a home healthcare industry leader with over 30 years of experience in scaling home health, hospice, and personal care platforms. As the CEO of New Day Healthcare, Scott has built one of the fastest-growing tech-enabled home care companies in the U.S., focused on AI-driven care delivery and operational efficiency.Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, Private Equity in Healthcare, Home Healthcare, AI in Healthcare, Medicare Advantage, Patient Acquisition, Scott Herman, New Day Healthcare,

Host Roy Bejarano sits down with Drew Franklin and Dr. Gavin Setzen, leaders in ENT and allergy care, to discuss the evolution of specialty healthcare, MSO development, and scaling a multi-site practice. They explore how healthcare leadership, patient access models, and value-based care innovations are reshaping the industry.In this episode, Drew and Gavin share healthcare industry insights on private equity vs. independent growth, optimizing clinical operations, and integrating ancillary services like allergy, audiology, and imaging. They also unveil an ENT urgent care model designed to improve patient access and cost efficiency.Timestamps:[00:01] Introduction to the podcast and guests, Drew Franklin & Dr. Gavin Setzen[04:00] The role of healthcare leadership in ENT & allergy care growth[12:00] Expanding an ENT practice: From a regional leader to a national brand[19:45] Private Equity vs. Independent Growth: Strategic decisions in healthcare business models[26:30] ENT Urgent Care & Ancillary Services: How innovations drive better patient outcomes[41:00] The Referral Challenge: Balancing specialty collaboration & in-house services[50:00] Value-Based Care & Healthcare Trends: Navigating new payer models & cost-efficient careKey Takeaways:ENT & Allergy Care Innovations Are Expanding: Urgent care, allergy services, and audiology offer new revenue streams and better patient care.Private Equity vs. Physician-Owned Models: Retaining clinical control and culture is crucial for long-term success.Value-Based Care & Payer Models Are Evolving: ENT groups must adapt to healthcare industry shifts for sustainable growth.Healthcare Leadership & MSOs Create Scalable Success: A dyad leadership approach (clinical + business expertise) is key to building efficient multi-site practices.Drew Franklin, MBA, FACMPE – Medical Practice Executive, ENT Administrator at ENT Specialty PartnersI’m a strategic advisor for Albany ENT and Allergy Services. I’ve been with the practice for four years. I’ve been in ENT for 18 years, having previously worked with ENT and Allergy Associates, which is the largest Ear, Nose and Throat practice in the country. I have my MBA from NYU Stern. I’m a fellow of the American College of Medical Practice Executives, and I’m very happy to be here.Gavin Setzen – CEO & President at Albany ENT & Allergy ServicesMy journey’s a little circuitous to Albany, having grown up in South Africa. I went to medical school in South Africa, did a short stint at a family practice, 60 miles north of North Dakota, waiting for my green card. I completed a partial general surgery residency in New York City. Before coming up to Albany, I completed my ENT Head and Neck surgery residency here and loved the Adirondacks, the upstate New York area. I had a great opportunity to take over the practice of a solo practitioner and have lived in upstate New York since that time. We developed a great platform in comprehensive otolaryngology here, growing the practice to now our 10th physician and onboarding our 20th physician assistant. We have a very diverse, broadbased, comprehensive type of practice and we can certainly talk more about the offerings and ancillaries and other care services that we provide. It’s been a very rewarding, important journey, and we’re glad to be providing care to upstate New York and contiguous communities in southern Vermont, Western Massachusetts, and the like.Healthcare, Healthcare Leadership, Healthcare Trends, Roy Bejarano, Healthcare Innovations, Healthcare Industry Insights, ENT Urgent Care, Value-Based Care, Medical Practice Growth, Private Equity in Healthcare, Drew Franklin, Dr. Gavin Setzen, specialty healthcare, MSO development, allergy care growth,